IS INSOMNIA A RISK FACTOR FOR POOR CPAP COMPLIANCE? THIS IS PROBABLY THE CASE ACCORDING TO AN ARTICLE IN SEPTEMBER SLEEP MEDICINE.

THIS ARTICLE IN SLEEP MED SEES LOW ADHERENCE TO CPAP AS A SERIOUS PROBLEM AND A "significant challenge for sleep medicine clinicians". THIS STUY FOUND THAT PATIENTS WITH PRE-TREATMENT COMPLAINTS OF INSOMNIA AS MEASURED BY " Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening". THE STUDY FOUND THAT "sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02)."

PATIENTS WITH COMPLAINTS OF INSOMNIA, PARTICULARLY SLEEP MAINTENANCE INSOMNIA MAY NOT BE GOOD CANDIDATES FOR CPAP TREATMENT. ORAL APPLIANCES ARE AN EXCELLENT ALTERNATIVE TO CPAP FOR PATIENTS WITH SLEEP MAINTENANCE INSOMNIA.

Sleep Med. 2010 Sep;11(8):772-6. Epub 2010 Jul 31.
Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series.
Wickwire EM, Smith MT, Birnbaum S, Collop NA.

Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, Columbia, MD 21044, USA. ewickwire@pulmdocs.com
Abstract
BACKGROUND: Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up.

METHODS: This was a retrospective chart review of 232 patients (56.5% men, mean age=53.6+/-12.4years) newly diagnosed with OSA (mean AHI=41.8+/-27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards.

RESULTS: Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02).

CONCLUSIONS: To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.

PMID: 20673741 [PubMed - in process]